Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-669899f699-swprf Total loading time: 0 Render date: 2025-05-01T00:49:26.719Z Has data issue: false hasContentIssue false

11 - Ensuring safety through evidence-based medicine

Published online by Cambridge University Press:  22 January 2010

Molly Courtenay  and
Matt Griffiths
By
Sharon Smart
Molly Courtenay
Affiliation:
University of Surrey
Matt Griffiths
Affiliation:
University of the West of England, Bristol
Get access

Summary

Introduction

To offer our patients high quality and safe care, we must be prepared to base our decisions on the best available evidence, continually evaluate our own practice and seek to improve it, learn from unexpected incidents and errors (whether these are our own or others'), and share uncertainty with our patients and the NHS (to help prioritise the research agenda). In this chapter I outline the principles of evidence-based medicine, briefly mention some of its limitations and describe how it can help you practise safely. The chapter focuses on therapeutic interventions, but it is important to be aware that evidence-based medicine can support safe practice in other ways, for example, by informing you about the accuracy of diagnostic tests, the prognosis of a condition, and the causes and risk factors for a disease.

Evidence and evidence-based medicine

What is evidence?

In its broadest sense evidence is information that is used to support the truth of a recommendation or conclusion. Evidence is found in a wide variety of sources such as published research, expert opinion, patient experience and audit data.

What is evidence-based medicine?

Evidence-based medicine has been defined as the integration of best research evidence with our clinical expertise and our patient's unique values and circumstances (Straus et al., 2000).

Type
Chapter
Information
Medication Safety
An Essential Guide
 , pp. 173 - 192
Publisher: Cambridge University Press
Print publication year: 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

,Antithrombotic Trialists' Collaboration (2002). Collaborative meta-analysis of randomised trials of antiplatelet therapy for the prevention of death, myocardial infarction and death in high risk patients. British Medical Journal, 324, 71–86.CrossRefGoogle Scholar
,Bandolier (2007). On limitations. Bandolier. www.jr2.ox.ac.uk/bandolier/band161/b161-2.html [Accessed 29.04.08].
Chou, R, Helfand, M. (2005). Challenges in systematic reviews that assess treatment harms. Annals of Internal Medicine, 142, 1090–9.CrossRefGoogle ScholarPubMed
Conroy, S, Choonara, I, Impicciatore, P, et al., (2000). Survey of unlicensed and off label drug use in paediatric wards in European countries. British Medical Journal, 320, 79–82.CrossRefGoogle ScholarPubMed
Dawes, M, Summerskill, W, Glasziou, P, et al., (2005). Sicily statement on evidence-based practice. BMC Medical Education, 5:(1), www.biomedcentral.com/1472–6920/5/1.CrossRefGoogle ScholarPubMed
,FFPRHC (2007). First Prescription of Combined Oral Contraception. Faculty of Family Planning & Reproductive Health Care, www.ffprhc.org.uk/admin/uploads/FirstPrescCombOralContJan06.pdf [Accessed 29.04.08].Google Scholar
Garg, AX, Adhikari, NKJ, McDonald, H, et al. (2005). Effects of computerized clinical decision support systems on practitioner performance and patient outcomes. Journal of the American Medical Association, 293, 1223–38.CrossRefGoogle ScholarPubMed
Grady, D, Herrington, D, Bittner, V, et al., ,HERS Research Group (2002). Cardiovascular outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). Journal of the American Medical Association, 288, 49–57.CrossRefGoogle Scholar
Haynes, RB. (2001). Of studies, syntheses, synopses and systems: the ‘4S’ evolution of services for finding current best evidence. Evidence Based Medicine, 6, 36–8.CrossRefGoogle Scholar
Hulley, S, Grady, D, Bush, T, Herrington, D, Riggs, B, Vittinghoff, E. (1998). Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. Journal of the American Medical Association, 280, 605–13.CrossRefGoogle ScholarPubMed
Ioannides, JPA. (2005). Contradicted and initially stronger effects in highly cited clinical research. Journal of the American Association, 294, 218–28.CrossRefGoogle Scholar
Kawamoto, K, Houlihan, C, Balas, EA, Lobach, DF. (2005). Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. British Medical Journal, 330, 765–8.CrossRefGoogle Scholar
McQuay, HJ, Moore, RA. (1997). Using numerical results from systematic reviews in clinical practice. Annals of Internal Medicine, 126, 712–20.CrossRefGoogle ScholarPubMed
O'Connor, AM, Rostom, A, Fiest, V, et al. (1999). Decision aids for patients facing health treatment or screening decisions: systematic review. British Medical Journal, 319, 731–4.CrossRefGoogle ScholarPubMed
Rossouw, JE, Anderson, GL, Prentice, R, et al., ,Writing Group for the Women's Health Initiative Investigators (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. Journal of the American Medical Association, 288, 321–33.Google ScholarPubMed
Rossouw, JE, Prentice, RL, Manson, JE, et al. (2007). Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since the menopause. Journal of the American Medical Association, 297, 1465–77.Google ScholarPubMed
Schulz, KF, Chalmers, I, Hayes, RJ, Altman, DG. (1995). Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. Journal of the American Medical Association, 273, 408–12.CrossRefGoogle ScholarPubMed
Stampfer, MJ, Colditz, GA, Willett, WC, Manson, JE, Rosner, B, Hennekens, CH. (1991). Postmenopausal oestrogen therapy and cardiovascular disease. Ten year follow-up from the nurses' health study. New England Journal of Medicine, 325, 756–62.CrossRefGoogle ScholarPubMed
Straus, SE, Richardson, WS, Glasziou, P, Haynes, RB. (2005). Evidence-based Medicine: How to Practise and teach EBM, 3rd edition. Edinburgh: Elsevier Churchill Livingstone.Google Scholar
,World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception (1995). Effect of different progestagens in low oestrogen oral contraceptives on venous thromboembolic disease. Lancet, 346, 1582–8.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×